On Thursday, November 17, the Centers of Medicare and Medicaid Services’ (CMS) held a teleconference, with both CMS representatives and Commercial Repayment Center (CRC) representatives available to provide long awaited explanations. The call served as a general update for cases processed through the CRC, as a means to issue reminders to stakeholders, and to allow the CRC to address and provide some answers for the backlog we have all experienced. The topics addressed on the call included pending Medicare Secondary Payer Recovery Portal (MSPRP) enhancements, lessons the CRC has learned during the first year of recovery, and some reminders related to ongoing responsibility for medicals (ORM) cases. A transcript of the call will be available within a week or two and we will make sure to post the transcript here on our blog. The CRC also outlined the time by which they expect to review the following types of correspondence from the date of receipt, as follows:

Authorizations: 45 days;

CPN disputes: 30 days;

CPL disputes: 45 days;

Post-demand redeterminations: 60 days; and

Payments: 20 days.

However, the CRC advised that quality assurance reviews are conducted on a sample of inbound correspondence, which can add to processing times and inevitable delays of the various types of communications handled.

The CRC also addressed the delays we have experienced with case development, and advised that prior to lead development all required information must be present on a case. In some cases, the delay may partially be due to missing information in the file, such as addresses. However, outbound correspondence from the CRC, is also subject to quality assurance reviews and may also be delayed as a result. The CRC further asserted that despite any perceived delays, their primary goal is to ensure accurate information is issued to the debtor through their internal processes.

During the call, the importance of providing accurate Section 111 data (ICD-9 and ICD-10 codes) was also discussed because the CRC has encountered many situations and disputes asserting that medical claims are unrelated. However, in many cases claims are deemed to be related based on the diagnosis codes initially reported.

In addition, the CRC described some of the pending MSPRP (portal) enhancements, which will include:

Case status information will be accessible through the portal;

Account receivables will be available for review through the portal;

Settlement information will be able to be uploaded through the portal;

Redetermination requests will be also be able to be submitted; and

Users will also be able to confirm redetermination statuses, including the date received, and decision status.

The Department of Treasury referral process was also reviewed on the call. A letter of intent to refer (ITR) is issued after 120 days after the demand letter date, as a reminder that if the debt is not paid or the post re-determination decision is not favorable, the case will then be referred to the Department of Treasury at day 180. It was further confirmed that an ITR letter may be issued while a redetermination request is still open, but a case will not be referred to the Department of Treasury, until all correspondence has been reviewed and processed.

Lastly, a CMS representative also addressed the recovery threshold determinations, as issued in their 09/26/2016 alert and 11/15/2016 alert. The most recent CMS alert announced that the threshold for physical trauma-based liability insurance will remain at $1,000 for the remainder of 2016 and then reduce to $750 on 01/01/2017. CMS will also maintain the $750 threshold for no-fault and workers’ compensation settlements, where the no-fault insurer or workers’ compensation entity does not otherwise have ongoing responsibility for medicals. This means that entities are not required to report, and CMS will not seek recovery on no fault, workers’ compensations and liability settlements as described in the recent alerts.

CMS expects to schedule more teleconference calls in the future. Please continue to check back frequently to make sure you don’t miss future announcements regarding CMS’ scheduled calls. If you have questions regarding CMS’ teleconference, or have conditional payment resolution questions, please contact our internal BCRC team, at BCRC@medval.com.

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To amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions